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NPI Code Detail

MEDICARE: JONATHAN D ROE MD

MEDICARE: JONATHAN D ROE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician35916-20WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3ROEJONOTHERWIMERCYCARE INSURANCE

General Provider Information

NPI Number : 1366507709
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN D ROE MD
Provider Business Mailing Address
First Line : 3400 DEERFIELD DR
Second Line :
City : JANESVILLE
State : WI
Zip : 53546-3557
Country : US
Telephone Number : 608-314-3600
Fax Number : 608-314-3601
Provider Business Practice Location Address
First Line : 3400 DEERFIELD DR
Second Line :
City : JANESVILLE
State : WI
Zip : 53546-3557
Country : US
Telephone Number : 608-314-3600
Fax Number : 608-314-3601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2006
Last Update Date : 04/16/2015

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